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bmj 2139 european journal of hospital pharmacy eahp european journal of hospital pharmacy eahp 0502013 132 pae 1 european journal of hospital pharmacy science and practice eahp survey2010 hospital pharmacy ...

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 BMJ 2139 European Journal of Hospital Pharmacy EAHP_European Journal of Hospital Pharmacy EAHP  0502013  132  Pae 1
                                                                     European Journal of
                                                                 Hospital
                                                                     Pharmacy
                                                                            SCIENCE AND PRACTICE
                EAHP 
         SURVEY2010
         Hospital Pharmacy Practice in Europe
         ejhp.bmj.com
             EAHP Survey 2010 on hospital pharmacy 
             in Europe
             Dr. Roberto Frontini, EAHP President
             Since 1995, every five years the European Association of Hospital Pharma-
             cists (EAHP) has compiled and published a comprehensive survey of hospital 
             pharmacy practice across Europe.  The fourth survey was conducted in 2010, 
             with data collected until January 2011.  It is a pleasure for me to present in 
             this booklet a summary of the results, which were published in a series in the 
             EAHP’s official journal, European Journal of Hospital Pharmacy: Science and 
             Practice (EJHP), in 2012 and 2013.
             The survey data are not presented question by question but rather are the-
             matically grouped into five chapters that encompass the spread of hospital 
             pharmacy activity: 
                   1.    General frame and staffing; 
                   2.    Procurement and distribution; 
                   3.    Production and quality assurance; 
                   4.    Clinical services and patient safety; and, 
                   5.    Education and research
             In this way we hope to give a more concise overview without making concessions on the provision of detailed information by coun-
             try, by type, and by size of hospital. Where sensible and according to the quality of the data gathered, we also make some compari-
             sons to the results of the 2005 and 2000 surveys. Whilst the scale of difference in questions asked in the first EAHP survey (1995) is 
             too high to allow comparisons with the 2010 data, it is still possible to track the developments in hospital pharmacy practice over 
             the last decade. This comparability challenge includes the fact that the survey’s reach, in terms of the number of countries covered, 
             has increased markedly since 2004, particularly in respect to new EU member countries. The published data are the result of some 
             iteration: after collection of the data the national coordinators scrutinised the results in terms of credibility and in some cases 
             returned to hospital pharmacies to make corrections to any missing or incomplete data. Some of the final results presented in this 
             document therefore contain amendments to the preliminary data presented at the EAHP Congresses in 2011 and 2012.  
             What is the scope of our survey? While we used statistical tools to analyse the data, the results should not be interpreted as ruth-
             lessly scientific – rather the survey is a useful ‘snapshot’ of practice. Despite our unique approach of contacting every hospital phar-
             macy in Europe, our survey has acknowledged result bias due to differing response rates from different countries and the potential 
             issues arising from different interpretation of the questions due to language barriers. Nevertheless the scope of the survey is to 
             give an overview of practice in European hospital pharmacies and this is important for our profession as well as for the EAHP. The 
             results clearly show gaps in levels of practice between countries and areas of practice where improvement should be an objective. 
             EAHP sets itself the mission of continuously improving hospital pharmacy practice in Europe for the benefit of patients. The data 
             collected by the survey supports EAHP in taking decisions on effective actions to achieve this, especially in terms of education and 
             exchange of experience. However, for every individual hospital pharmacist the survey offers the opportunity to compare practice 
             in their own country or hospital with that in other European countries. In this respect, the survey results are designed to provide 
             an effective benchmarking tool for self-directed practice improvement in every European health system. There is no such thing as 
             perfect practice but there are certainly centres of excellence from which we can all learn.
        It is impossible to report all of the survey information in this booklet and we recognise that colleagues may be interested in addi-
        tional details. It is for this reason that we have included the original questionnaire in this booklet.  A range of information about, and 
        from, the survey is also available on the EAHP website at www.eahp.eu/publications/surveys.  Individuals with further queries are 
        invited to contact the EAHP office and ask for additional analysis of the responses to a specific question. It should be understood 
        that due to the complexity and sensitivity of the original data EAHP is not able to make available the primary data. 
         EAHP has always aimed to create a continuously improving survey. So now, with over 15 years of experience acquired in this project 
        area, further refinements and modifications to future surveys are planned. These changes will aim to ensure that both the rigour 
        and the usefulness of the exercise are maintained and built upon. Although still subject to discussion, one suggestion under consi-
        deration is for more regular, but shorter, survey activity. This could increase the precision of the survey as a tracking mechanism of 
        practice improvement and innovation in Europe. In whatever event, as EAHP’s membership and reach continues to extend, and as 
        information technology opens up new avenues for data collection previously not possible, I am confident that EAHP surveys will 
        continue to benefit of all those who draw inspiration and conclusions from their findings.
        I convey my gratitude to my two EAHP Board colleagues who have led in the compilation of the survey, Tajda Miharija Gala (Slo-
        venia) and Juraj Sykora (Slovakia). Without their engagement and intensive communication with the national coordinators, no 
        reliable data would have been collected and the survey could not have been compiled. 
        My sincerest gratitude extends to all of the national coordinators who had the challenging task of convincing their colleagues to 
        take the time and effort to complete the survey and provide the necessary data. Some of these coordinators went further, by pro-
        viding translations of the questionnaire and making significant entries of data into the central database. The survey results and this 
        booklet are the reflection of, and a tribute to, those efforts. 
        EAHP SURVEY NATIONAL MEMBER COORDINATORS 
        AUSTRIA                Silvia HETZ                    HUNGARY                Gyöngyver SOOS
        BELGIUM                Raphaël COLLARD                IRELAND                Joan PEPPARD
                               Sofie VERBEKE                  ITALY                  Ilaria UOMO
        BULGARIA               Nina PURVANOVA                 LATVIA                 Valdis PIRSKO
                               Ilko GETOV                     LITHUANIA              Birute VARANAVICIENE
        BIH                    Enisa SALIHEFENDIĆ             LUXEMBOURG             Patrick ENGELHARDT
                               Tijana MARINKOVIĆ              NETHERLANDS            Rob MOSS
        CROATIA                Marijeta DUKARIĆ KURTIĆ                               Hans OVERDIEK
                               Ana CRNKOVIĆ                   NORWAY                 Frank JØRGENSEN
        CZECH REP.             Helena ROTTEROVA               PORTUGAL               Aida BATIST
                                                                                               A
                               Petr HORAK                     POLAND                 Dariusz SMOLINSKI
        DENMARK                Helle McNULTY                  SERBIA                 Dragana RAJINAC
                               Gitte NIELSEN                  SLOVAKIA               Juraj SYKORA
        ESTONIA                Tiia VALS                      SLOVENIA               Tajda MIHARIJA GALA
        FINLAND                Hanna TOLONEN                  SPAIN                  María José TAMES
        FYROM                  Maja KOVAČEVA                                         Eduardo ECHARRI 
        FRANCE                 André RIEUTORD                 SWITZERLAND            Susanna KUSSMANN
        GERMANY                Steffen AMANN                  SWEDEN                 Per NYDERT
        GREECE                 Despina MAKRIDAKI              UK                     Richard CATELL
                                                                                                                                                                                                                               
                                                                                                                                                                                                                                       EAHP Survey 2010                                                                              EAHP Survey 2010
                     EAHP Survey 2010 on hospital pharmacy in Europe:                                                                                                                                                                                                                                                                                                                                                                                                                                                        The majority of hospitals (n=1102) in 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Europe are publicly owned (81%). Private 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      hospitals (10%) and church affiliated 
                     Part 1. General frame and staffing                                                                                                                                                                                                                                                                                                                                                                                                                                                               hospitals (4%) are less frequent. Of all 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      of the hospitals, 79% (n=1168) were 
                                                                   1,2                                                          1,3                                    1,4,5                                                                                                                                                                                                                                                                                                                                          general hospitals (teaching=36%, non-
                     Roberto Frontini,  Tajda Miharija-Gala,  Juraj Sykora                                                                                                                                                                                                                                                                                                                                                                                                                                            teaching=43%). Hospital pharmacies from 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      psychiatric (5%), oncology (3%), geriatric 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      (2%) and ophthalmic hospitals (0.4%) also 
                     In 2010, the European Association of Hospital Pharmacists (EAHP) conducted its fourth survey on hospital pharmacy                                                                                                                                                                                                                                                                                                                                                                                participated in the study.
                     practice in Europe. 4748 heads of pharmacy were contacted in all member states through a network of national                                                                                                                                                                                                                                                                                                                                                                                            One hospital pharmacy serves a median 
                     coordinators. 1283 hospital pharmacies from 30 countries answered the questionnaire with an overall response rate of                                                                                                                                                                                                                                                                                                                                                                             of 410 complete hospitalisation beds in 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Europe (n=1139, average 606 beds) and 
                     27.0%. The average number of beds served by one pharmacy had not changed since 2005 but there was a decrease in                                                                                                                                                                                                                                                                                                                                                                                  the distribution was fairly homogeneous 
                     complete and an increase in partial hospitalisation. Pharmacists (27%) and qualified technicians (32%) make up 60% of                                                                                                                                                                                                                                                                                                                                                                            for hospitals with between 100 and 1500 
                     the total staff. The number of pharmacists/100 beds varies from 0.24 (Bosnia and Herzegovina) to 4.35 (UK). Only a few                                                                                                                                                                                                                                                                                                                                                                           beds (table 2). From the perspective of total 
                     countries did not experience shortages of pharmacists and technicians. European hospital pharmacy staffing (pharmacists                                                                                                                                                                                                                                                                                                                                                                          number of beds served, small hospitals (<300 
                     and pharmacy technicians) remains, on average, low compared with the USA and has not grown significantly since 1995.                                                                                                                                                                                                                                                                                                                                                                             beds) covered only 7.5% and very large ones 
                     Therefore, it can be problematic to make direct comparisons between hospital pharmacy services in the USA and Europe.                                                                                                                                                                                                                                                                                                                                                                            (>1.500 beds) 35.7% of the total beds.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             There were significant differences 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      between countries in relation to the average 
                     Introduction                                                                              significant, NC translated the questionnaire                                             of questionnaires sent out in that country,                                                                                                                                                                                                                                                                   number of beds served by one hospital 
                     The pan European survey on hospital                                                       and thus improved the response rate and                                                  multiplied by 87 (total number of questions).                                                                               Figure 1  Contribution (%) of single countries to the total number of responses. Percentages are weighted on                                                                      pharmacy (only complete hospitalisations, 
                     pharmacy practice is an important source                                                  number of correct answers.                                                               The total weighted response rate was 16.7%.                                                                                 the basis of answered questions. BiH, Bosnia and Herzegovina; FYROM, Former Yugoslav Republic of Macedonia.                                                                       figure 2). The largest numbers were in 
                     in understanding the future challenges and                                                       The collected data were analysed by                                                      Response rates varied substantially                                                                                                                                                                                                                                                                    Denmark (2974), Germany (1566), the 
                     needs for development in Europe. In 2002, the                                             country (30 European countries), by size of                                              across the member states. The highest                                                                                                                                                                                                                                                                         UK (1310), Lithuania (1249), Austria 
                     European Association of Hospital Pharmacists                                              the hospital (number of beds—12 groups), by                                              response rate was achieved in FYROM                                                                                            Table 2  Distribution o hospita pharmaies b number o beds sered n   113­€                                                                                               (1203) and the Czech Republic (1115). 
                     (EAHP) General Assembly, in Portorozˇ,                                                    type of hospital (seven groups) and also in                                              (Former Yugoslav Republic of Macedonia)                                                                                        ‚pe o pharma b ƒo o                                                                                                                                                      Comparisons with the survey from 2000 
                     Slovenia, decided to run the survey every                                                 comparison with previous EAHP surveys.1 2                                                were all hospital pharmacies answered the                                                                                      beds sered  ompete and                                                                                         ƒo o beds                                                  and 2005 (figure 2) showed that in most 
                     5 years. In 1995, 18 countries participated,                                              Where appropriate, we also compared                                                      questionnaire (table 1). Very good response                                                                                    partia  hospitaisations€                      ƒo o pharmaies                „ o a pharmaies                sered in tota            „ o tota beds                  of the countries there was a trend towards 
                     in 2000, 16 countries, in 2005, 22 countries                                              the results with the American Society                                                    rates above 50% were also found in Austria,                                                                                    1–…­                                               15                             1.3                                   5……                     0.1                            increasing the number of beds served, which 
                     and in 2010, 30 countries participated.                                                   of Health System Pharmacists (ASHP)                                                      Croatia, Estonia, Latvia, Luxembourg,                                                                                          50–­­                                             53                             ….7                                  3888                      0.5                            was probably caused by the closing and 
                                                                                                               National Survey 2011.3                                                                   Slovakia and Slovenia. The poorest response 
                             The 2010 survey was based on a                                                                                               We performed only                                                                                                                                                            100–1­­                                          168                            1….7                                2…­85                       3.1                            merging of pharmacies.
                     questionnaire with 87 questions covering                                                  descriptive analysis of the data but further                                             rates were in France, Lithuania, Poland and                                                                                    200–2­­                                          12…                            10.­                                30…3…                       3.8                                   The average number of beds served by 
                     the following major topics:                                                               investigation will be performed in the future.                                           the UK.                                                                                                                        300–3­­                                          138                            12.1                                …7…56                       5.­                            a single hospital pharmacy (complete and 
                         1.   General frame and staffing                                                                                                                                                       Each single question was answered                                                                                       …00–5­­                                          18…                            16.2                                ­062­                      11.3                            partial hospitalisations) increased between 
                                                                                                               Results                                                                                  by a median of 960 (74.8%) of the 1283                                                                                         600–7­­                                          126                            11.1                                85…63                     10.7                             2000 and 2010, from 648 to 708 beds (median 
                         2.   Procurement and distribution                                                     The average response rate was 27.0%                                                      responding pharmacists (minimum 64                                                                                             800–­­­                                           73                             6.…                                65706                      8.2                             2010=427). While complete hospitalisations 
                         3.   Production and quality assurance                                                 (1283/4748). As not all of the questions                                                 (5.0%), maximum 1168 (91.0%)). The                                                                                             1000–1…­­                                        137                            12.0                               166701                     20.8                             decreased, partial hospitalisations had an 
                         4.   Clinical services                                                                were answered in the questionnaires, we                                                  number of responding pharmacists to a                                                                                          1500–2000                                         55                             ….8                                ­3700                      11.7                            upward trend, showing a shifting in hospital 
                         5.   Patient safety                                                                   also calculated a weighted response rate,                                                specific question is indicated as n (number)                                                                                   >2000                                             66                             5.8                               1­2…37                     2….0                             services to day care.
                         6.   Education and research.                                                          which is the ratio between the total number                                              and all results (in %) are related to the n of                                                                                                                                                                                                                                                                       The major groups of staff in hospital 
                     Methods                                                                                   of answered questions and the total number                                               the single question.                                                                                                               The highest total number of responses                                             country to the total n (1283 hospital                                                    pharmacies (ie, full time equivalents 
                     A total of 4748 heads of pharmacy were                                                                                                                                                                                                                                                                         was achieved in Italy (117=39.0% of                                                      pharmacies=100%) are displayed in figure 1.                                              (FTE)) were qualified pharmacy assistants/
                     contacted in all member states through a                                                     Table 1  Response rates by ontry                                                                                                                                                                                pharmacies) and Germany (130=30.8%).                                                     Percentages are weighted on the basis of the                                             technicians (PT, 32%), followed by 
                                                                                                                                                                                                                                                                                                                                    The contributions of each respective                                                     answered questions.                                                                      pharmacists (27%), non-qualified pharmacy 
                     network of national coordinators. The role                                                                               Response rate                    eihted                                                 Response rate                    eihted                                                                                                                                                                                                                                     assistants (14%) and administrative staff 
                     of the national coordinators (NC) was to                                                     ontry                      ­                               ­                       ontry                         ­                               ­                                                                                                                                                                                                                                          (8%). Prescriptionists (bachelor of pharmacy) 
                     provide the contact addresses of the heads of                                                €stria                       8‚.‚                            71.2                     ƒta„y                           3….0                            30.…                                                                                                                                                                                                                                         are employed in some north European 
                     the hospital pharmacies and then motivate                                                    †e„im                       27.0                            15.6                     ‡atˆia                          75.7                            56.‚                                                                                                                                                                                                                                         countries but play only a minor role (1%).
                     them to take part in the survey, as well as                                                  †i‰                           ‚0.0                           30.5                      ‡ithania                       10.…                              5.8                                                                                                                                                                                                                                               The average number of 
                     facilitating completion of the questionnaire.                                                †„aria                      30.‚                            23.6                     ‡Šembor                     100.0                            68.6                                                                                                                                                                                                                                         pharmacists/100 beds (FTE in 
                     In countries where the language barrier was                                                  roatia                       81.5                            53.8                     ‹ether„ands                     2‚.7                             11.2                                                                                                                                                                                                                                        complete + partial hospitalisations) was 
                                                                                                                  Œeh                         61.2                           ‚0.1                      ‹orŽay                          56.3                            33.…                                                                                                                                                                                                                                         1.1 (median 0.9) but there were large 
                                                                                                                  Repb„i
                     1                                                                                            ‘enmar’                       63.6                            ‚….2                     “o„and                           15.1                             6.0                                                                                                                                                                                                                                        differences across Europe (figure 3).
                       European Association of Hospital Pharmacy, Brussels, 
                     Belgium                                                                                      ”stonia                       …0.0                            67.7                     “orta„                        ‚1.7                            28.6                                                                                                                                                                                                                                                The country with the highest ratio was 
                     2                                                                                            •in„and                       33.1                            18.8                     –erbia                          56.3                            33.5
                       Universitätsklinikum Leipzig, Leipzig, Germany                                                                                                                                                                                                                                                                                                                                                                                                                                                 the UK (4.35)  and Bosnia and Herzegovina 
                     3                                                                                            •rane                          5.0                             1.5                    –„oˆa’ia                        …3.5                             7‚.6
                       University Medical Centre Ljubljana, Ljubljana, Slovenia                                                                                                                                                                                                                                                                                                                                                                                                                                       had the lowest (0.24). In terms of total 
                     4                                                                                            •—R˜™                       100.0                            72.3                      –„oˆenia                        …2.0                             67.2
                       National Cancer Institute, Bratislava, Slovakia                                                                                                                                                                                                                                                                                                                                                                                                                                                staff/100 beds the highest ratio was also 
                     5                                                                                            šermany                       30.8                            1….5                     –pain                           26.8                             13.7
                       Slovak Medical School, Bratislava, Slovakia                                                                                                                                                                                                                                                                                                                                                                                                                                                    in the UK (12.59) and the country with 
                                                                                                                  šreee                        2‚.2                            17.…                     –Žeden                          50.0                            33.3                                                                                                                                                                                                                                         the lowest ratio was Lithuania (1.45). The 
                     Correspondence to                                                                            ‰nary                       ‚‚.‚                            35.7                     –ŽitŒer„and                      57.5                           38.…                                                                                                                                                                                                                                         average across Europe was 3.8 (median 3.5).
                     Dr. Roberto Frontini, Direktor Universitätsklinikum                                          ƒre„and                       63.6                            35.‚                     ›œ                              3‚.5                              8.8
                     Leipzig – AöR Apotheke Liebigstr. 20, 04103 Leipzig,                                         †i‰ž †osnia and ‰erŒeoˆina; •—R˜™ž •ormer —os„aˆ Repb„i oŸ ™aedonia.                                                                                                                                        Figure 2  Average number of beds served by one pharmacy by country (n = 1139). BiH, Bosnia and                                                                                           The number of pharmacists and PT 
                     Germany; Roberto.frontini@medizin.uni-leipzig.de                                                                                                                                                                                                                                                               Herzegovina; FYROM, Former Yugoslav Republic of Macedonia.                                                                                                                        (FTE) classified by the number of hospital 
                     European Journal of Hospital Pharmacy 2012;19:385–387. doi:10.1136/ejhpharm-2012-000162                                                                                                                                                                      385                                               386                                                                                            European Journal of Hospital Pharmacy 2012;19:385–387. doi:10.1136/ejhpharm-2012-000162
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...Bmj european journal of hospital pharmacy eahp pae science and practice survey in europe ejhp com on dr roberto frontini president since every five years the association pharma cists has compiled published a comprehensive across fourth was conducted with data collected until january it is pleasure for me to present this booklet summary results which were series s official are not presented question by but rather matically grouped into chapters that encompass spread activity general frame staffing procurement distribution production quality assurance clinical services patient safety education research way we hope give more concise overview without making concessions provision detailed information coun try type size where sensible according gathered also make some compari sons surveys whilst scale difference questions asked first too high allow comparisons still possible track developments over last decade comparability challenge includes fact reach terms number countries covered increas...

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